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Home My WebLink About4-27-40Paid by CEMETERY Receipt No. 9!1 ........Dated ..........7 .11.4.1.9 .7........Lots-.: . 40 NO. List Price S 11600 : b0 """ 600.00 Maximum No. Burial Spaces ................ Unit Block4 G 1 Net Paid $ .................. Monument permitted....................... (Data above this line for City Record only) Vtg of Orhaottan �rkutrtrr_q 13rrll NO. THIS INDENTURE MADE TWs .14th ............. day of ............. July ........................ A. D., 19.9...., between like City of Sebastian, a municipal corporation existing under the laws of the State of Florida, as Grantor and .........................................Thomas.. and Lor..Ma.ryanm..Nir,.o�et.t.i...................................... 135 Hinchman Avenue .......................................... Sebastian,...Flor•ida • •3.2.95a................................................. of the County of Indy an„River Florida ............ ...................... and stats of .............. ................................ u Grantee, WITNESSETHa That the Grantor for and in consideration of the sum of $ 1 660.60 . to it in hand p . �....................... paid, the receipt whereof is herewith so- knowledged, does by this instrument grant, bargain, sell, release, convey and confirm unto the Grantee their hairs, legal representatives and assigns the following property situated in Sebastian, Indian River County, Florida, to -wit: Ali of Lot(sP9 & 4R , Block, 2 T.... , UNIT . A .......... , of Sebastian municipal cemetery as per Plat Number 1 thereof recorded In Plat Book 2, at page 65 of the public records in the office of the Clerk of the Circuit Court of St. Lucia County of Florida; said land now lying and being in Indian River County, Florida. To Have and to Hold the same forever; provided that said property shall be used solely and exclusively for the interment of the human dead and shall be used, kept and maintained at all times in accordance with the rules and regulations, ordinances and resolutions of the City of Sebastian, Florida, hereto- fore, now and hereafter adopted or provided for the government and operation of said cemetery. The conditions, restrictions and requirements contained in this instrument shall be covenants running with the land. In the event of the failure of the owner of any property situated within said cemetery to ob- serve and comply with such rules, regulations, resolutions and ordinances and the conditions of the deed of conveyance thereof then the title of such owner in and to said property shall terminate and the same stall revert to the City of Sebastian, Florida. IN WITNESS WHEREOF, The said party of the first part has ®used this instrument to be executed in its name and on its behalf by its Mayor and attested by its City Clerk and its corporate seal to be hereto affixed, the day and year first above written. CITY OF SEBASTIAN, FLORIDA ;js—..%.... By Y.V.. k/V..y............... City Clerk Mayor Signed, Scaled and Delivered in the P ounce of. .................. STATE OF FLORIDA COUNTY OF INDIAN RIVER 14th July 97 1 1[EILEBY CERTIFY, That on this ........................dry at ..................................................., 19...., before me personally appeared.Wlater W. BarnKathr n M. ' Halloran ......... . es .................................... and ........ y..........0... ........... reaprctively Mayor and City Clerk pf the City of Sebastian, a municipal corporation under the laws of the State of Florida to me known to be the ludividuuls and officers described In and who executed the foregoing conveyance to ................................ ................................................ .................................................. and severally acknowledged the execution thereof to be their tree act and deed as such officers thereunto duly uuthorlsedi and that the Official seal of said corporation Is duly affixed thereto, and the said conveyance is the act and deed. of said corporation. WITNESS my signature and official seal at Sebastian, In the Ca my of n Ian RiverState of Florida, the day and year last aforesaid. a 11 19 I UNDA M. (114111f MY COMMISSION / Ix << F.XPIflES: Jur 18. 111111111 otary uletic, BMW Ito it "F� A thW@ns a My co lulon Linda M. leV,...t Lar..... �............... Dries at Large. y FLORIDA DEPARTMENT OF HiAl A. (TYPE) State of Florida, Department of Health, Vital Statistics APPLICATION FOR BURIAL - TRANSIT PERMIT T - J v MO 7 1. Name of First Middle Last Date Month Day Year Deceased of Thomas Frank Nicoletti Death Nov. 12 2001 2. Place of Death City, Town or Location Name of (If neither, give street address) County Hosp. or Indian River Vero Beach Inst. Indian River Memorial Hospital 3. Name of Medical Address Phone Number Certifier Pedro A. Espat, D.O. 8005 Bay Street, Suite 3 Medical Examiner Physician Sebastian, FL 561-589-5600 4. Name of Funeral Home/Direct Disposal Address Fla. Lic. No./Reg. No. Phone No. (Area Code) Establishment 1623 N. Central Avenue Strunk Funeral Home Sebastian, FL 1228 561-589-1000 5. Check Appropriate Box a. LJ The medical certification has been completed and signed. A completed certificate of death accompanies this application. b. M Lisa was contacted on 11/12/01 He/she verified that this death was from natural causes, that there was no accident nor other external cause of death, and that Dr. Espat will complete and sign the medical certification of cause of death within 72 hours. C. F1 was contacted on He/she verified that Medical Examiner, will complete and sign the me cal a 'kation of us,W death within 72 hours. 6. Funeral Director/ nature F.E. No./Reg. No. Date Signed Direct Disposer- 11/12/01 B. BURIAL - TRANSIT PERMIT Permission is hereby granted to dispose of this body. Permit No. 1228-01-0543 A five (5) day extension of time for filing the death certificate (exclusive of weekends) has been requested and granted since the physician has been contacted by the funeral director and will not be able to complete the medical certification of cause -of -death section of the death certificate within 72 hours. [:]No extension of time for filing the death certificate has been requested. -Registm or- Date Date Certific to Subregistrar Signature / Issued: ////2/Q Due: J1 17 01 C. AUTHORIZATION for CREMATION, DISSECTION, or BURIAL -AT -SEA Approval Number: Date Medical Examiner, gave authorization by telephone to Funeral Director/Direct Disposer. Date The Medical Examiner's approval must be obtained before disposal by any of the above methods. A waiting period of 48 hours after death is required for all cremations. D. CEMETERY OR CREMATORY Method of Disposition: Place of Disposition Sebastian Cemetery ®BURIAL STORAGE Date of Disposition CREMATION OTHER (Specify) Signature of Sexton or Person -in -Charge / This permit must be endorsed by the Sexton or person -in -charge (or by the Funeral Director/Direct Disposer when there is no Sexton) and returned within 10 days to the local County Health Department in the county where disposition occurred. Distribution: White: Cemetery or Crematory DH 326, 8197 (Obsoletes all previous editions) Yellow: Funeral Director or Direct Disposer (Stock Number 5740-000-0326-2) Pink: Local Registrar D 0 N CD CL Cr K r W Cz X I m d E ' CITY OF SEBASTIAN CITY CLERK'S OFFICE RECEIPT irlapts _,. ❑ Cash Check0 001001208001 Sales Tax Amount 001501322900 Garage Sales 001501341920 Copies/Bid Specs. i 001501341910 LDC/Code of Ordinances 001501362100 Community Center Rent 001501362100 Yacht Club Rent 001501362150 Non Taxable Rent 001501343800 Cemetery Lots I 601010 343800 Cemetery Lots I Lot/Niche , Block Unit 001501369400 Interment Fee 001501369400 Weekend Service k, 680800 220681 Yacht Club Security Deposit 660800 220682 Community Center Security Deposit t' F 680800220683 Rivewiew:Park Security Deposit E I r Total PaW htidttls White - Dept. of Otioin • ToAow -Pham • Pink - Appliant